P.O. Box 1160 P.O. Box 702 Durant, OK 74702 Talihina, OK 74571 (580) 920-7027 (918) 567-3582 INSTRUCTIONS FOR PETITIONING FOR A CHANGE OF NAME 1. Read all instructions and example pages carefully. 2. You must type your own Petition for Change of Name. Do not fill-in the blanks on this form. (You will be known as the Petitioner for purposes of this court case.) 3. Type your Petition for Change of Name, Order for Hearing and Notice of Hearing on letter-size (8½ x 11 ) paper. Type on ONE SIDE ONLY of each page. Use as many or as few pages as needed for your situation. 4. Present or mail the Petition for Change of Name, Order for Hearing, Notice of Hearing, Information Sheet, a copy of your CDIB card and your payment to the Court Clerk. (Do NOT mail your original CDIB card to the Court Clerk.) 5. The Court Clerk will file the Petition for Change of Name and present the Order for Hearing to the District Judge to set a court date. The District Judge will sign and complete the form and return it to the Court Clerk. 6. The Court Clerk will complete the Notice of Hearing and will sign the form. The Clerk will return a copy of the Order Setting a Hearing and a copy of the Notice of Hearing to you. 7. Take the completed Notice of Hearing to a newspaper authorized to publish legal notices in the county where you live and pay to have it published one time in the newspaper. The Notice must be published at least ten (10) days before the scheduled court date. 8. The newspaper will provide you with a document called proof of publication. Make sure the proof of publication is filed with the Court Clerk before the date of your hearing. 9. Type the Order for Change of Name to take the order to court with you on the date set for hearing on the Petition for Change of Name. 10. At the conclusion of the hearing, if you prevail at the hearing, the judge will sign the Order for Change of Name. You may want to get several certified copies from the Court Clerk, so you can have your name changed on important legal documents. IMPORTANT: Neither the District Court of the Choctaw Nation nor the Court Clerk s office provides lawyers, legal advice, or legal assistance. If you need/want legal advice or representation, you must retain your own lawyer at your own expense. If you select a lawyer to represent you, he/she must be admitted to practice law in the courts of the Choctaw Nation of Oklahoma and must be a member of the Choctaw Nation Bar Association. Name Change Packet revised 2-1-18 1
ENCLOSE THE FOLLOWING WITH YOUR PETITION: When you are ready to mail or personally bring your Petition for Change of Name, Order Setting a Hearing and Notice of Hearing to be filed with the Court Clerk s office, you MUST bring the following in order to file your Petition: 1. Copy of your CDIB/membership Card. 2. Information sheet (THIS MUST BE COMPLETED AND RETURNED ALONG WITH YOUR PETITION). 3. Credit Card (Please see attached One Time Credit Card Payment Authorization Form), cashier s check or money order for $50.00 payable to the Choctaw Nation Judicial. We cannot accept cash or personal check. If you have questions, you may reach the Court Clerk's office in Talihina at (918) 567-3582 or the Court Clerk's office in Durant at (580) 920-7027. Mail all correspondence to either address shown at the top of the page. If filing in person, you may use the Choctaw Nation Court Clerk's office in Durant, located at 523 West Main Street or the Choctaw Nation Court Clerk's office in Talihina, located in the BIA Building at 302 Church Street. 2
One Time Credit Card Payment Authorization Form Sign and complete this form to authorize Choctaw Nation to make a one-time debit to your credit card listed below. By signing this form you give us permission to debit your account for the amount indicated. This is permission for a single transaction only, and does not provide authorization for any additional unrelated debits or credits to your account. Please complete the information below: I authorize Choctaw Nation to charge my credit card (full name) account indicated below for $50.00. This payment is for. (Description of services) Billing Address Phone# City, State, Zip Email Account Type: Visa MasterCard Cardholder Name Account Number Expiration Date SIGNATURE DATE I authorize the above named business to charge the credit card indicated in this authorization form according to the terms outlined above. This payment authorization is for the goods/services described above, for the amount indicated above only, and is valid for one time use only. I certify that I am an authorized user of this credit card and that I will not dispute the payment with my credit card company; so long as the transaction corresponds to the terms indicated in this form. 3
PETITIONER INFORMATION TYPE OF CASE NAME CHANGE NAME: Last First: Middle: ADDRESS: CITY: STATE: ZIP: DATE OF BIRTH: TELEPHONE: ALTERNATE NUMBER: E-MAIL: TRIBAL AFFILIATION: MOTHER S INFORMATION NAME: Last First: Middle: ADDRESS: CITY: STATE: ZIP: DATE OF BIRTH: TELEPHONE: ALTERNATE NUMBER: E-MAIL: TRIBAL AFFILIATION: FATHER S INFORMATION NAME: Last First: Middle: ADDRESS: CITY: STATE: ZIP: DATE OF BIRTH: TELEPHONE: ALTERNATE NUMBER: E-MAIL: TRIBAL AFFILIATION: 4
IN RE: THE NAME CHANGE OF: CASE NO: CV- PETITION FOR CHANGE OF NAME COMES NOW the Petitioner,, and alleges and states to the Court the following, to wit: 1. That Petitioner,, of lawful age, is a resident of Indian Country as defined by 18 U.S.C. Section 1151, and said residence is located at the address of:, which is within the territorial jurisdiction of the Choctaw Nation of Oklahoma. 2. That said Petitioner has resided in the Choctaw Nation of Oklahoma, for more than thirty (30) days preceding the filing of this Petition. 3. That said Petitioner is a member of the Tribe, which is a federally recognized Indian Tribe. 4. That the date of birth of the Petitioner is: [Insert DATE OF BIRTH], in the city of [Insert CITY OF BIRTH], [Insert COUNTY OF BIRTH] County, [Insert STATE OF BIRTH]. The Petitioner s birth certificate number is [Insert BIRTH CERTIFICATE NUMBER]. The birth certificate is registered with the [Insert NAME OF STATE AGENCY WHERE BIRTH CERTIFICATE IS REGISTERED IN OKLAHOMA IT IS THE STATE REGISTRAR OF VITAL STATISTICS]. 5. That the Petitioner herein desires to have his/her [select his or her] name changed to [Insert NEW NAME]. 6. That the Petitioner desires to have his/her [select his or her] name changed because. [Insert facts to accurately reflect why the name change is desired.] 7. That Petitioner does not desire to change his/her name for any illegal or fraudulent purposes or to hinder creditors. 5
WHEREFORE, upon hearing, Petitioner requests the Court to change the name of Petitioner to [Insert NEW NAME], and to reflect that the appropriate records reflect this change together with such other and further relief as the Court deems fair and equitable. Respectfully submitted, PETITIONER S NAME PETITIONER S ADDRESS Phone Number: VERIFICATION I, the undersigned individual, of legal age, being first duly sworn upon oath, do state that I have read the foregoing Petition for Change of Name and freely state under penalty of perjury that it is true and correct. Signature Printed Name Signed and sworn before me this day of 20. Notary Public My Commission Expires: My Commission Number: 6
IN RE: THE NAME CHANGE OF: CASE NO: CV- ORDER FOR HEARING PETITION FOR CHANGE OF NAME NOW on this day of, 20, the above styled and numbered Petition for Change of Name comes before the Court. The Court being fully advised in the premises, does hereby set this Petition for Change of Name for hearing on the day of, 20, at 9:00 AM at the Choctaw Nation court room located at 302 Church Street in Talihina, Oklahoma, 74571 before the undersigned Judge. Judge of Choctaw Nation District Court 7
IN RE: THE NAME CHANGE OF: CASE NO: CV- NOTICE OF HEARING ON PETITION TO CHANGE NAME THE CHOCTAW NATION OF OKLAHOMA TO: All interested persons Take notice that has petitioned to change his/her name to. A Hearing on said petition is set for 9:00 a.m. on the day of, 20, before Hon. in his courtroom located in the Choctaw Nation District Courthouse at 302 Church Street in Talihina, Oklahoma, 74571. Should you know of some reason why this change of name should not be allowed, you must file a written protest in the above styled and numbered cause prior to the above date with the Clerk of this Court. Should you fail to do so, the petition for change of name will be granted as prayed. CHOCTAW NATION COURT CLERK By: DEPUTY Name: Address: Notice to Publisher, Publish once at least 10 days prior to the date set for the hearing. 8
IN RE: THE NAME CHANGE OF: CASE NO: CV- ORDER CHANGING NAME THIS matter came on for hearing this day of, 20, before Hon., District Judge of the Choctaw Nation of Oklahoma, upon the verified Petition for Change of Name filed by to change his/her name to that of, which was filed in this court on the day of, 20. The Petitioner appeared in person, pro se, and the Court, having heard sworn testimony and there being no objection, finds: 1. That this Court has jurisdiction to hear and decide this matter in that the Petitioner is a resident of Indian Country as defined by 18 U.S.C. Section 1151, and that said residence is located at the address of:, which is within the territorial jurisdiction of the Choctaw Nation of Oklahoma. 2. That said Petitioner has been domiciled in the Choctaw Nation of Oklahoma as an actual resident for more than thirty (30) days preceding the filing of this Petition. 3. That said Petitioner is a member of the Tribe, which is a federally recognized Indian Tribe. 4. That notice of filing of said petition has been given by publication in a newspaper of general circulation in the county of the State of Oklahoma where the Petitioner resides, which is located inside the territorial jurisdiction of the Choctaw Nation of Oklahoma, for more than 10 days prior to this hearing as more particularly reflected by the proof of publication contained by the files of this court in the above styled and numbered case. 5. That the date of birth of the Petitioner is: [Insert DATE OF BIRTH], in the city of [Insert CITY OF BIRTH], [Insert COUNTY OF BIRTH] County, [Insert STATE OF BIRTH]. The Petitioner s birth certificate number is [Insert BIRTH CERTIFICATE NUMBER]. The birth certificate is registered with the [Insert NAME OF STATE AGENCY WHERE BIRTH CERTIFICATE IS REGISTERED IN OKLAHOMA IT IS THE STATE REGISTRAR OF VITAL STATISTICS]. 6. That petitioner desires to have his/her named changed from to and that said petitioner is entitled to such relief for the reasons set forth in said verified Petition for Change of Name and that Petitioner does not seek to have his/her name changed for any illegal or fraudulent purpose or to delay or hinder creditors. 9
IT IS THEREFORE ORDERED, ADJUDGED AND DECREED BY THE COURT that Petitioner s name is and the same is hereby changed from to, and that copies of this order may be furnished to the necessary agencies to make such change upon Petitioner s official records with such agencies. IT IS SO ORDERED this day of, 20. JUDGE OF CHOCTAW NATION DISTRICT COURT 10